1083657860 NPI number — KUNA CHIROPRACTIC FAMILY CARE CENTER PC

Table of content: (NPI 1083657860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083657860 NPI number — KUNA CHIROPRACTIC FAMILY CARE CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KUNA CHIROPRACTIC FAMILY CARE CENTER PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083657860
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 215
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KUNA
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83634-0215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-922-5057
Provider Business Mailing Address Fax Number:
208-922-5087

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
675 W. 4TH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KUNA
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83634-2004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-922-5057
Provider Business Practice Location Address Fax Number:
208-922-5087
Provider Enumeration Date:
06/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROSENLUND
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
AUBREY
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
208-922-5057

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CHIA 942 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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